Surgery for the Thyroid
Typically, we either recommend taking out half, or all of the thyroid. If a patient has a nodule on one side of the thyroid which is either indeterminate according to the list above, or benign but enlarging, a hemi-thyroidectomy can be an option. This involves taking out the half of the thyroid which contains the nodule. This is beneficial if the thyroid is functioning normally, since patients may not need thyroid medications long term. The part of the thyroid which is removed is then examined for cancer. It usually takes at least 48 hours for the results. If cancer is found, the other half of the thyroid will need to be removed, which means a second surgery must be performed. This is done to provide optimum treatment and follow up care for thyroid cancer.
Alternately, if there are nodules on both sides of the thyroid, hyperthyroidism, or thyroid cancer, then the whole thyroid is removed with a total thyroidectomy. This surgery takes around 2 hours to perform, and patients are asleep under general anesthesia for this time. After this surgery is done, the patient will need to take thyroid medication every day for the rest of their lives.
The Risks Involved with Thyroid Surgery Include
- Bleeding – usually less than a teaspoon of blood is lost, but this depends on the diagnosis and blood vessels supplying the gland.
- Infection – the risk of infection is very low.
- Injury to the nerves in your vocal cords – the possibility of injury to the nerves controlling the vocal cords is a significant concern. It can be an injury that the surgeon recognizes, or it can be unrecognized during the surgery. This injury can lead to hoarseness which is typically temporary; it is permanent in <1% of cases. It is not unusual to have a slightly raspy voice after the surgery for a couple of days simply due to the breathing tube used for anesthesia.
- Bleeding and possible airway obstruction
- A sharp rise in thyroid hormone levels (only around the time of surgery)
- Parathyroid gland – these glands are next to the thyroid gland and can be bruised or accidently removed or experience blood loss. Damage to these glands will lead to low blood calcium which is usually treated with calcium supplements.
Recovery Following Surgery
The recovery after thyroid surgery is usually fairly well tolerated. Occasionally, it is necessary to stay one night in the hospital, but most patients go home the same day. Due to the risk of low calcium after the operation as listed above, patients are typically recommended to take calcium supplements for 2 weeks after surgery.
You can usually eat and drink normally the night of the surgery. The incision is normally closed with dissolvable sutures and surgical tape or surgical glue. A small bandage may be placed on your neck following surgery and will normally be removed the following morning. There are no dietary restrictions.
You will be able to shower the very next morning and the incision can get wet. However, no swimming or soaking in a tub for a month.
Patients normally feel well following the surgery, but will have fatigue for approximately 2 weeks. This is simply due to healing from having a surgery – think of it as the body putting energy into healing as top priority. Since most patients don’t feel ‘ill’ before surgery, this can be aggravating to patients. The only restriction after surgery is no driving for 3 days.
Pain usually is controlled with pain medications taken by mouth and many patients switch over to Tylenol or Advil within 24 hours of surgery.
Thyroid medication is usually started the day after surgery. Thyroid medication is given to absolutely all patients who have had their whole thyroid gland out. This medication will be necessary to take every day for the rest of your life. If you have had a hemi-thyroidectomy, a low dose of medication is typically given for a short period of time to help the remaining thyroid rest, which reduces the likelihood of forming a nodule on the opposite side. Please wait at least 30 minutes after taking your thyroid medication before taking your calcium supplement, and at least 1 hour before eating. This will allow better absorption of your thyroid medication. The thyroid medication simply does not absorb into the system if it is not alone in your stomach. Some patients opt to take the medication at bed time; it is necessary to make sure that it is taken on an empty stomach in this situation as well.
The thyroid medication dosage will initially be based on a patient’s weight. This is then adjusted to levels measured in the blood with simple blood tests approximately 6 weeks after surgery. Because it takes the body awhile to adjust to changes in the medication, there may be 4 – 6 weeks between adjustments in the dose and blood tests. Many patients fear that they will gain weight on thyroid medication. There may be some fluctuations in weight around the time of your surgery, but once the medication is adjusted to your normal function, as determined by your levels before surgery, then there should be no weight gain. This has been the subject of multiple research studies, and the research shows that there is no statistical change that is not accounted for based on changes in exercise, diet, or age. (Yes, we do tend to gain pounds as we age.)